Smoking Cessation- Prescribing Points

• Smoking remains the biggest preventable cause of ill-health and premature death and the biggest driver of health inequalities particularly cancer, coronary heart disease and respiratory disease.
• All patients, wherever they are, who wish to quit smoking can be referred to the Leicestershire NHS STOP! Smoking Service.  
• Behavioural therapy should always be provided alongside pharmacotherapy either as direct provision or by the STOP! Smoking Service, as it significantly increases the chance of quitting successfully.
• Most smokers need to make multiple attempts to quite before achieving long-term success.Treatment should be available for more than one episode providing patients are adequately motivated to attempt to stop smoking again.
• Appropriate governance mechanisms should be in place to provide comprehensive advice on treatment, monitor use, agree quit dates and a plan of ongoing support at the end of treatment.
• Smoking is not allowed on secondary care premises.
• Smoking cessation medications should be chosen according to patient specific requirements. Consider patient preference, motivation, cigarettes smoked per day, the time to the first cigarette of the day, desired speed of nicotine delivery, ability to adjust and titrate nicotine dose, tolerance for side effects, interactions and ease of use.  In more dependent smokers a combination of short and long acting NRT should be considered to relieve craving.
• NRT can be prescribed for in-patients over the age of 12 years for the short term management of craving and withdrawal symptoms. 
• All in-patients who smoke should be encouraged to agree to referral to STOP! Smoking Service. In patients unwilling to be referred for smoking cessation NRT can be offered for temporary abstinence or to allow a reduction in smoking in line with NICE PH45 Tobacco: harm reduction approaches to smoking.
• Smoking cessation can affect levels of medication and dose adjustment may be necessary e.g. clozapine.  Further information and advice can be obtained from the Medicines Information Service on 0116 258 6491.
• The risks and benefits of NRT should be discussed with pregnant women who smoke, particularly those who do not wish to accept the offer of help from the NHS Stop Smoking Service. If a pregnant woman is unable to give up without pharmacological therapy the risks of NRT are lower than those of smoking tobacco  Pregnant women using nicotine patches should be advised to remove them before going to bed (use for 16 hours per day).